Hip Replacement Surgery and Blood Clots What You Need To Know
This leaflet was developed and funded by the Pfizer/BMS Alliance in partnership with Anticoagulation Europe.
This leaflet is intended for patients undergoing hip replacement surgery to help increase understanding and awareness of the risks posed by blood clot formation in the deep veins of the leg. To learn more, please contact Anticoagulation Europe by phone on +4420 8289 6875, or visit us online at www.anticoagulationeurope.org.
This is Michael. He is 69 years old and has arthritis. His hip is very painful and stiff and is becoming creakier. He can still get about, but he wouldn’t fancy trying to dance anymore.1 He potters about in the garden since he retired, but finds it difficult to dig and increasingly hard to bend down to weed the borders. Michael needs to have a hip replacement and has heard that one particular risk can cause problems after surgery...
This risk is from blood clots. But…What are they really? And… What is he at risk of? Michael knows from childhood that if you fall and graze your knee, any bleeding normally stops quickly. A blood clot or scab plugs the hole to stop the bleeding and let the body rebuild the damaged area.2 He is worried about his hip replacement because he knows that removing the worn out parts involves making a deep wound. The Nurse—Maria—answers these questions when he goes to the clinic.
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Nurse Maria explains that the kind of blood clot or scab seen on the knee is a natural and essential function that also occurs inside the body when it is injured. Special substances in the blood make it sticky to slow down bleeding.3 Special substances also make the cells in the blood clump together (known as ‘clotting’) to provide a natural ‘safety net’ that plugs holes, thereby stopping blood from escaping.3
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It is important to get the right amount of clotting, in the right place and at the right time. After surgery, blood clots can form inside a vein. If a clot blocks the vein, this causes a problem. The nurse goes on to describe how...
Blood vessels are used constantly to transport the essential things the body uses, such as oxygen, to where they are needed. Blood vessels are also used to move things that the body has finished with (such as carbon dioxide, ammonia and waste products created by metabolism) so that they can be disposed of.4 These functions are vital to life.
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Surgery upsets the body’s natural balance for clotting. After a big operation, the body is on full alert and stands guard, ready to prevent blood loss by making clots if you start to bleed. The special substances that make blood sticky are released while the body is in this protective state.5 All of the time that the body is working to stop any bleeding, it is pumping blood around the blood vessels making sure that organs such as the brain and heart are getting enough oxygen to keep them healthy.
When you rest in bed following surgery, the blood flow in the legs becomes sluggish, as these muscles are not being used. When we are being active, the leg muscles help to pump blood back up to the heart. When your muscles contract, they exert a squeezing force on the blood vessels that they surround, thereby moving the blood along (imagine trying to get the last bit of toothpaste out of the tube). If the legs are not used for a long time, it is possible for pools of blood to build up in the veins.6
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If blood pools in the legs when it is sticky, clots can develop even though they are not needed. This happens because the blood is not being moved around enough, thereby giving it a chance to clump together.6 When a blood clot develops in a vein in the leg it is called a deep vein thrombosis . It can cause swelling so that one leg looks bigger than the other. It may also feel warmer or may become painful. 7,8 However, it is also important to bear in mind that some people may not experience any symptoms.
When you start to walk around again, the unwanted clots may become dislodged and get washed away to another part of the body.
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If the unwanted clots get washed away to your lungs, this causes a pulmonary embolism . In a pulmonary embolism, the clot reduces the blood flow through the lungs, meaning fewer red blood cells can collect oxygen to deliver around the body. If not treated quickly, a pulmonary embolism can be fatal.9
Unwanted blood clots can be prevented from forming in the first place by a medicine called an anticoagulant . This is given to you by your hospital doctor. It helps your body to slow down the clotting process.10
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Some people are more at risk of developing blood clots than others. As such, it is very important that you have a discussion with your doctor before your operation to let them assess your own level of risk and prescribe the best treatment. After your operation, you should have a second risk assessment. If you have not been made aware of having this risk assessment, it is essential that you ask for it.
Following his operation, Michael was given exercises to help to pump the blood around his legs, as well as anticoagulant medication. He is looking forward to an improved life. The danger from unwanted blood clots can last for several
weeks after your operation. It is very important that any anticoagulant medicine be taken daily for as long as your doctor tells you.10
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References: 1. Based on National Joint Register 8th Annual Report statistical data showing that over 90% of hip and knee replacements in the UK are for osteoarthritis http://www.njrcentre.org.uk/njrcentre/default.aspx. 2. McGrath A. Overcoming the challenge of overgranulation. Wounds UK 2011;7:42-49. 3. Anaesthesia UK. Coagulation—the classical model. http://www.frca.co.uk/article. aspx?articleid=100096. 4. Blood and Haemostasis. Chapter 14. In Principles of Physiology. Edited by Berne RM and Levy MN. Pub: Wolfe Publishing Ltd London. 1990. 5. Kristiansson M, Soop M, Sundqvist KG, et al. Local vs. systemic immune and haemostatic response to hip arthroplasty. Eur J Anaethesiol 1998;15(3):260-270. 6. American Academy of Orthopedic Surgeons. Deep Vein Thrombosis. http://orthoinfo. aaos.org/topic.cfm?topic=a00219. 7. Worden J. Deep Vein Thrombosis. NetDoctor. http://www.netdoctor.co.uk/travel/ diseases/dvt.htm [Last accessed October 2011]. 8. Khan SR. The Post Thrombotic Syndrome in Hematology 2010. American Society of Hematology. 2010. 9. ESC Taskforce. Guidelines on the diagnosis and management of acute pulmonary embolism. Euro Heart J 2008;29:2276-2315. 10. Geerts WH, Bergqvist D, Ineo GF, et al. Prevention of Venous Thromboembolism. American College of Chest Physicians Evidence-based Clinical Practice Guidelines (8th Edition). Chest 2008;133:381S-453S.
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Notes:
Remember… Blood clots—if you are not told about this risk, ask your doctor whether he or she has done a risk assessment before your surgery and ask again afterwards. Please take your medicine for as long as your doctor asks you to. Call your doctor immediately if you do get any of the following symptoms:9 • Shortness of breath • Blood spots on a tissue or in your mouth when you cough • Chest or shoulder pain • Dizziness or fainting • Lower leg pain, swelling, redness or heat compared to the opposite leg
Name:_____________________________________________ Hospital:___________________________________________ Hospital Doctor’s name and contact details: __________________________________________________ General Practitioner’s name and contact details: __________________________________________________ MEDICATION. THIS PERSON IS TAKING IN CASE OF ANY PROBLEMS, PLEASE CONTACT HIS OR HER DOCTOR AT THE NUMBER LISTED ABOVE.